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Commentary

Patient Access to EHRs - How Much Should Doctors Share?

The use of electronic health records (EHRs) is now standard operating procedure in many medical practices, but access to them is a bone of contention. While many patients want to
be able to read and add to their records, doctors may not be comfortable with this.

An online survey of over 9,000 people conducted by Accenture to assess consumer
perceptions of their medical providers’ electronic capabilities found that about 84% of patients believed they should have full access to their EHRs, while only 36% of doctors shared this
belief. In fact, 65% of U.S. doctors said patients should have only limited access to their records. This is what most patients (63%) say they currently have.

Why this reluctance to
share on the part of doctors? The survey found that doctors’ concerns over patient access to EHRs really center on issues of accuracy. When several people can access and edit a file, it
increases the chance of confusing or inaccurate information being entered in a patient’s record.

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Most doctors say they are willing to have patients make minor changes to their
records, such as updating their family medical history (88%) or allergies (85%). These are details that patients routinely fill out when they visit the doctor’s office.

On the other hand, the majority of doctors did not want patients editing their own records with details on lab test results, new symptoms they experience, or medications they’ve been
prescribed. Their concern is that a patient may incorrectly enter the name of a medication or put a decimal in the wrong place on a test result.

On the plus side, EHRs can be used
to foster patient engagement, especially when patients can access notes from their office visit. Patients often retain very little of what’s discussed in the doctor’s office, so being able
to go home and look up the notes from their visit presents a real opportunity for education and involvement.

A recent study by researchers at Harvard Medical School found that when
doctors let patients view their progress notes—the part of the medical record doctors were most reluctant to share—patients' compliance with medications increased.

The one-year study involved 105 primary care physicians from medical centers in Massachusetts, Pennsylvania, and Washington. After the doctors entered visit notes into patients’ EHRs,
patients were invited via email to read the notes on their respective patient portals.

Of the over 13,000 patients who participated, nearly 90% viewed one or more notes. In a
post-intervention survey (completed by about 6,000 patients), 77-87% of patients reported that having access to the notes helped them feel more in control of their care. Of those taking medications,
60-78% reported increased medication adherence. Ninety-nine percent of patients said they wanted to continue to have access to their notes after the study.

Interestingly, at the end
of the study, 70% of physicians said that note sharing had strengthened their relationship with patients and improved patient satisfaction, patient safety, and patient education.

As healthcare educators, we believe that giving patients access to their medical record and letting them interact with it instead of just carrying it from one doctor’s office to
another opens the door to engagement and a more collaborative patient-provider relationship. We encourage doctors to introduce patients to their EHRs and discuss how to use them to update their health
information and strengthen their understanding of their medical conditions and treatment.

Doctors should share EVERYTHING on a read only basis. Systems should allow patients to make "sticky note" comments on any info that they think needs updating. This data can them be reviewed for system acceptance. But that would mean more review work for clinicians. It might even be wise to track change history (dates, values, reasons.) We do this for grade changes on University systems.

It would be worth it, especially wrt updating meds. Even within healthcare delivery systems the data is often wrong. Once you are prescribed a drug, it seems to live for ever in multiple meds lists and data bases. Many patients, especially Old Age Pensioners aren't very aware of drug names/dosages/dates prescribed. Increasingly, not all clinicians share the same EHRs. Many patients have primary care docs and specialists in different systems. It is too often the case that a patient must coordinate all the data from and for everyone. If you want me to keep you up to date then I need to see my information.

The bottom line is that you can pretty much do anything you want with the data systems technologically. The harder part is changing processes and the hardest part is changing attitudes of people in the system.